Healthcare Analytics – Payor/Provider Finance Data and AI, Managed Care Contracting & Optimization

Job description

Job Family: Data Science Consulting Travel Required: Up to 10% Clearance Required: None What You’ll Do: The Healthcare Finance Data and AI team translates healthcare data into measurable healthcare financial performance. This role is dedicated to managed care contracting – you will learn to read payer contracts (commercial and government), model reimbursement terms in our existing tools, and enhance those tools with automation using SQL and Python. You will partner with contracting, revenue integrity, and patient financial services teams to ensure our modeled rates and rules align with contract language and adjudication behavior, and you will turn findings into clear, executive-ready recommendations. Learn and interpret payer contracts (fee schedules, DRG/APC, per diem, percent-of-charge, case rates, carveouts, stoploss/outlier, multiple procedure reductions, modifiers, bundling/packaging rules, lesser-of logic, escalators, effective dates, term/renewal, amendments). Translate contract terms into machine-readable logic and configure/model those terms in our existing pricing/adjudication tools. Validate modeled results by reconciling remittance advice (835/ERA) and historical paymen...